OP0046 REAL-WORLD ORAL GLUCOCORTICOID USE IN SYSTEMIC LUPUS ERYTHEMATOSUS: A NATION-WIDE POPULATION-BASED STUDY USING THE FRENCH NATIONAL MEDICO-ADMINISTRATIVE DATABASE (LUPIN-F STUDY)
Authors: L. Arnaud, C. Fabry-Vendrand, R. Todea, B. Vidal, C. Juliette, J. Robert, S. Bouée, G. Thabut
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> The daily dose of oral glucocorticoids (OCS) is associated with damage in Systemic Lupus Erythematosus (SLE), and OCS reduction is a major goal of SLE care. However, evidence regarding the real-world use of OCS in nation-wide populations are currently lacking. <h3>Objectives</h3> The aim of this study was to analyze the use of OCS in French patients with SLE, at the national level, using medico-administrative data. <h3>Methods</h3> This study used the French health-insurance claims database (SNDS), which contains pseudonymized individual data for over 66 million people. SLE patients were identified with the ICD-10 diagnosis code for SLE (M32), documented as a chronic condition or associated to hospital stay. Included SLE patients were defined as patients alive on January 1<sup>st</sup> 2020 whenever the SLE diagnosis occurred. SLE comorbidities and OCS complications were identified through validated algorithms. Real-world use of treatments was identified through drug deliveries in pharmacies and daily OCS doses (expressed in prednisone-equivalent) were calculated for the year 2019. Comparisons were made to age- and gender-matched controls without SLE from the general population. <h3>Results</h3> A total of 32,173 patients with SLE (mean age 49.9 ± 16.0 years; 86.1% women) were alive on January 1<sup>st</sup> 2020, with a mean disease duration of 7.1 ± 6.2 years. Among these prevalent SLE patients, 48.2% were treated with OCS. The mean daily dose of OCS was below 5 mg/day in 35.7%, between 5 and 7.5 mg/day in 6.4% and above 7.5 mg/day in 6.1%. OCS use was significantly more frequent in women, in patients with CMUc (specific health coverage for low income patients) and decreased with age (p&lt;0.0001, for all). SLE-specific comorbidities, including glomerular disease, skin involvement, polyarthritis, pleurisy, pericarditis, and thrombocytopenia, were significantly increased in patients with higher doses of OCS (p&lt;0.0001, for all). Use of SLE treatments other than OCS was significantly increased in patients with higher doses of OCS (p&lt;0.0001, for all) (Table 1). Strikingly, 14.6% of patients receiving 5 to 7.5 mg of OCS per day and 14.2% of those receiving more than 7.5 mg per day were not treated with antimalarial drugs, immunosuppressives or other biologic treatments for SLE. Complications of OCS, including cardiovascular diseases, infections, osteoporosis, and obesity, were significantly increased in SLE patients receiving ≥ 5 mg per day of OCS (p&lt;0.0001 for all). The overall annual mean cost of healthcare consumptions from a societal perspective in 2019 was 6,048€ for prevalent SLE patients and 2,601€ for matched controls (p&lt;0.0001). Among prevalent SLE patients, the cost increased significantly according to the OCS daily dose: 4,633€ for patients without OCS, 6,383€ (daily dose of 0-5 mg/day), 9,815€ (5-7.5 mg/day) and 13,861€ (above 7.5 mg/day). <h3>Conclusion</h3> To the best of our knowledge, this is the first nation-wide study reporting on real-life use of OCS in patients with SLE. The proportion of patients treated with high-dose OCS ≥ 7.5mg/day remains unacceptably high and associated with increased comorbidities, OCS complications and significantly increased healthcare costs. Also, over 14% of patients receiving OCS doses ≥ 5 mg/day were not treated with antimalarial drugs, immunosuppressives or other biologic treatments for SLE. These results highlight the need for tight disease control and implementation of robust OCS-sparing strategies in SLE. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Laurent Arnaud Consultant of: Abbvie, Alexion, Alpine, Amgen, AstraZeneca, Biogen, BMS, Boehringer-Ingelheim, GSK, Grifols, Janssen, LFB, Lilly, Kezar, Medac, Novartis, Oséus, Pfizer, Roche-Chugaï, Sêmeia, UCB, Caroline Fabry-Vendrand Employee of: AstraZeneca, Remus Todea Employee of: AstraZeneca, Blandine VIDAL Employee of: AstraZeneca, Cottin Juliette Grant/research support from: I am employed by the company CEMKA who receive grants by pharmaceutical companies to conduct epidemiological and economic studies, Julien Robert Grant/research support from: I am employed by the company CEMKA who receive grants by pharmaceutical companies to conduct epidemiological and economic studies, Stéphane Bouée Grant/research support from: I am employed by the company CEMKA who receive grants by pharmaceutical companies to conduct epidemiological and economic studies, Gabriel Thabut Employee of: AstraZeneca.